HMO Collaboration Quality Improvement and Patient Safety

1. HMO CollaborationQuality Improvementand Patient Safety Michigan Health and Safety Coalition April 15, 2004 Barbara Kopasz Health Alliance Plan Inter Plan Patient Safety Council

2. Employer Health Care Concerns • Cost • Double digit rate increases • Health care as growing percentage of total labor cost • Hospital rate increases, drugs and new technology costs driving trends • Quality • Inefficiencies/errors in care delivery • Patient Safety Concerns • Poor coordination of care for people with chronic conditions; aging population • Limited “Best Practice” sharing/measurement

3. Employer Health Care Concerns • Utilization • Waste in the healthcare delivery system • Inappropriate use (misuse, overuse and underuse) of health care services • Wide variation in practice patterns between communities

4. Health Plan Role Consumer Purchaser Expect to Meet Needs Hold Accountable Health Plan • Provide Quality Leadership • Hold Delivery System Accountable for Value • Provide Delivery System With • - Information - Coordination • - Support - Communication • Selection and Contracting Delivery System Hospital Primary Care Physician Pharmacy Behavioral Health Home Health Care Specialty Physician Other Therapeutic Services Diagnostic Services Centers of Excellence

5. Employer Framework • Look at the data: cost, quality, utilization, performance indicators • RFIs • HEDIS • Measure the performance of health plan and providers • Share performance information with consumers • Reward high-quality performance and penalize poor-quality performance

6. Health Plan Challenges • Employer Specific Initiatives • RFI’s • Provide comparative data to purchasers • Plan Administration • Health Promotion • Chronic Disease Management • HEDIS • Pharmacy Management • Patient Safety • Customer Satisfaction • Community Initiatives

7. Driving collaboration and change in Michigan • Tobacco cessation benefit design • Interplan Patient Safety Workgroup • MI Health & Safety Coalition, collaborative implementation of safety standards, common messages for members • Interplan Behavioral Health Workgroup • development of depression and substance abuse guidelines, common patient release form • Individual plan experiences • MQIC

8. History of Health Plan Collaboration • History of working together to address common issues regarding the “eValue8” RFI formerly GDAHC • Creating the Inter-Plan Patient Safety – natural evolution • RFI challenges • Employer accountability • Many health plans worked with GM Top 11 initiatives • MQIC

9. Purchasers’ Expectations • Foster an approach to patient safety • Emphasis on systemic improvements • Reward superior efforts to reduce errors • Fulfill Leapfrog purchasing principles: • Educate and inform enrollees • Highlight Leapfrog recommended patient safety practices • Reward superior provider value

10. Purchasers’ Expectations • Determine the rate at which members were at risk for preventable medical mistakes during a recent hospitalization due to the absence of one or more of the Leapfrog recommended patient safety practices. • Calculate the admissions going to hospitals that have implemented one or more of the standards relevant to the condition and have a strategy to increase the rate • Recognize and reward hospitals and encourage member admissions to compliant hospitals

11. Patient Safety“Michigan Inter-Plan Patient Safety Council” • RFI Expectations: • Written Patient Safety Strategic Plan • Activities to inform contracted hospitals, practitioners and members about Leapfrog standards and reporting requirements • Activities to develop and disseminate information on what members can do to reduce the chance they will be subject to preventable medical errors • Activities to monitor use of hospitals that meet Leapfrog standards • Activities to increase the percentage of members admitted to hospitals that meet the Leapfrog standards.

12. RFI Expectations • Develop and provide educational materials to: • Health Plan contracted hospitals • Health Plan contracted practitioners • Health Plan members • Ability to rank hospitals based on survey scores • Make data available to providers and members • Develop hospital report cards • Encourage members to seek services at hospitals that meet the Leapfrog standards

13. Patient Safety Expectations • Monitor hospital compliance with JCAHO National Patient Safety Goals • Support hospital quality and safety improvements beyond Leapfrog and JCAHO • Support hospital performance on the National Quality Forum measures • Encourage rural hospital participation in the survey

14. Patient Safety: Future Activities • SEM Health Plans will continue to collaborate on common issues to reduce burden to hospitals • SEM Health Plans will continue to work with MHA on identifying common patient safety initiatives • E.g. stroke program • Other initiatives being discussed: • Further collaboration on development of member education materials • Pharmacy workgroup coordination • Rural hospital outreach • Continue to identify efficiencies to reduce hospital burden re: data collection • Create inventory of hospital patient safety initiatives

15. Inter-Plan Patient Safety Council • Health Plan Participants: • Blue Care Network • Care Choices • HAP • Health Plus • MCare • Paramount • Priority Health

16. Summary • Poor quality is costly and is a problem facing all of us • Failure to consider quality when purchasing healthcare IS part of the problem • Employers believe the way to reduce health care cost is to improve quality…and provide people with the information on quality to make smart health care decisions • Going forward we will continue to attack the epidemic of medical mistakes with better systems, accountability, more training and education and exchanging knowledge to advantage one another

17. “Together we can assemble a system that is stronger and more reliable than the sum of its parts; not perfect but much better.” Source: “Internal Bleeding” Robert M. Wachter, M.D. and Kaveh G. Shojania, M.D.