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AHRQ and the Science of Public Reporting Presentation to National Advisory Council

AHRQ and the Science of Public Reporting Presentation to National Advisory Council Irene Fraser and Carol Sniegoski July 22, 2011. Public Reporting One Potential Strategy to Improve Quality . Two Theories of Impact Consumer pathway Consumers use info. to choose providers

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AHRQ and the Science of Public Reporting Presentation to National Advisory Council

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  1. AHRQ and the Science of Public Reporting Presentation to National Advisory Council Irene Fraser and Carol Sniegoski July 22, 2011

  2. Public ReportingOne Potential Strategy to Improve Quality • Two Theories of Impact • Consumer pathway • Consumers use info. to choose providers • Market shares shift, providers respond • Provider pathway • Providers value their reputations and/or market shares so strive to improve scores • More evidence on second pathway • But science is nascent • Transparency also an end in itself • Growing comparative reporting by CMS, states, communities, others • Role grows under the ACA

  3. Goals for Discussion • Summarize AHRQ role in public reporting • Present one new tool: MONAHRQ • Your ideas on priorities for enhancement? • Discuss new multi-year initiative on the Science of Public Reporting • Your ideas on strategies, themes, issues?

  4. AHRQ Has aSignificant Role in Public Reporting • Does NOT do provider-level reporting, but • Develops measures • CAHPS • Quality Indicators • Readmissions measures • CHIPRA and Adult Medicaid Measures • Reports national and state data • National Healthcare Quality and Disparities Reports • State Snapshots • Provides tools for CMS, states, others to use

  5. CMS, States, Others Use AHRQ Measures for Public Reporting • CMS – Uses H-CAHPS, Quality Indicators for Hospital Compare and Value-Based Purchasing • States – also use H-CAHPS and Quality Indicators for Public Reporting • 25 states use Quality Indicators for public reporting

  6. AHRQ Has a Significant Role in Public Reporting (cont’d) 5. Provides clearinghouse, inventories • National Quality Measures Clearinghouse 6. Improves data for public reporting 7. Conducts (some) research on public reporting 8. Provides TA, learning networks for users of public reports • Example: 24 Chartered Value Exchanges • Multi-stakeholder • Represent over 124 million lives • Major activity is public reporting • AHRQ leads learning network

  7. Learning Network Example: 24 Chartered Value Exchanges 8 8 23 23 17 17 13 13 9 9 15 15 12 12 3 3 24 24 10 10 11 11 19 19 18 18 21 21 4 4 16 16 1 1 2 2 22 22 5 5 6 6 14 14 20 20 7 7

  8. AHRQ Role in Measures Reporting: An Example from HCUP and the Quality Indicators

  9. Goals for Discussion • Summarize AHRQ role in public reporting • Present one new tool: MONAHRQ • Your ideas on priorities for enhancement? • Discuss new multi-year initiative on the Science of Public Reporting • Your ideas on strategies, themes, issues?

  10. Tour of MONAHRQ MONAHRQ overview • MONAHRQ introduction • Report from MONAHRQ users: KeelyCofrin Allen, Utah Department of Health • MONAHRQ goals and future directions

  11. But … building a reporting site is tough MONAHRQ motivation • Growing need to publicly report healthcare quality and costs at the local level • Building an effective reporting site is even tougher Why does every organization have to reinvent the wheel?

  12. Introducing MONAHRQ • Software that quickly generates your own local public reporting website • Fast • Easy • Automatic • Free • Use your local data or use publicly available measures • Designed by AHRQ to follow best practices in reporting – Selected as finalist in the Fall 2010/Winter 2011 HHSinnovates competition –

  13. MONAHRQ origins MONAHRQ builds on other AHRQ programs MONAHRQ Hospital Costs and Utilization Project AHRQ Quality Indicators (HCUP) (QIs) • Online data query (HCUPnet) • AHRQ QI R&D Community health collaboratives • AHRQ QI software tools • MONAHRQ benchmarks (CVEs) • AHRQ QI users • Potential adopters • Reporting experience

  14. MONAHRQ makes reporting easier Download MONAHRQ from monahrq.ahrq.gov MONAHRQ

  15. MONAHRQ makes reporting easier Download MONAHRQ from monahrq.ahrq.gov Load your local hospital discharge data MONAHRQ Load CMS Hospital Compare measures* • * Publicly available from Hospital Compare

  16. MONAHRQ makes reporting easier Download MONAHRQ from monahrq.ahrq.gov Load your local hospital discharge data MONAHRQ Load CMS Hospital Compare measures* MONAHRQ runs on your desktop Output a healthcare reporting website You host: internal, password-protected, or public • * Publicly available from Hospital Compare

  17. The MONAHRQ reporting website • Hospital Quality Ratings • Maps of Avoidable Hospital Stays • Hospital Utilization • County Rates of Hospital Use

  18. MONAHRQ adoption • First released June 2010 • 4 live statewide reporting sites, plus 2 expected soon

  19. MONAHRQ tour:Hospital Quality Ratings • AHRQ Quality Indicators • CMS Hospital Compare measures • HCAHPS measures

  20. Hospital Quality Ratings:Search page Choose hospitals and a health topic

  21. Hospital Quality Ratings:Search page [Search page]

  22. Hospital Quality Ratings:Classification table Compare hospital quality ratings • * Available from HealthData.gov

  23. Hospital Quality Ratings:Bar charts Drill down to bar charts with benchmarks – Synthetic data –

  24. Hospital Quality Ratings:Detailed statistics tables Drill down to underlying measure statistics – Synthetic data –

  25. MONAHRQ tour:Maps of Avoidable Hospital Stays AHRQ area-level Quality Indicators Reflect quality of community care, not hospital care

  26. Maps of Avoidable Stays: Search page Choose a measure [Search page]

  27. Maps of Avoidable Stays: County maps Compare rates of potentially avoidable hospital stays by county – Synthetic data –

  28. Maps of Avoidable Stays: Potential cost savings Drill down to estimated cost savings from reducing avoidable stays – Synthetic data –

  29. Visit our new live MONAHRQ demo site monahrq.ahrq.gov/demo/index.html – Synthetic data –

  30. Report from MONAHRQ users KeelyCofrin Allen Utah Department of Health

  31. MONAHRQ goals • Encourage local reporting • Disseminate best practices in reporting • Encourage use of endorsed measures (without enforcing it) • Help to harmonize local reporting • Provide options to help tailor local reports to local needs

  32. Future plans • Add new features • Time trends • Custom benchmarks • Summary pages • Targeted reports (e.g., pediatrics) • More customization options • Add new content • Additional Compare measures • Custom measures • Plans, ACOs, or exchanges • Cost and quality • Summaries or composites • EHR meaningful use • All-payer claims data • Collaborate, assist and assess • Stakeholder feedback • Technical support • User groups • Add best practices • New initiative on Building the Science of Public Reporting

  33. Email us:carol.sniegoski@ahrq.hhs.govanne.elixhauser@ahrq.hhs.gov Contact us For more information or to visit our live demo site: monahrq.ahrq.gov For assistance or to join the MONAHRQ mailing list: email monahrq@ahrq.gov Input Your Data. Output Your Website.

  34. Discussion • Questions about MONAHRQ? • Suggestions for future directions? • How to guide MONAHRQ planning or facilitate MONAHRQ adoption? Input Your Data. Output Your Website.

  35. Goals for Discussion • Summarize AHRQ role in public reporting • Present one new tool: MONAHRQ • Your ideas on priorities for enhancement? • Discuss new multi-year initiative on the Science of Public Reporting • Your ideas on strategies, themes, issues?

  36. The Science of Public Reporting Initiative Goals: • Forge a coordinated, evidence-based strategy for public reporting at the national and local levels • Improve science of public reporting • Incorporate this science in national and local reports • Improve data for public reporting • Assess impact

  37. Key questions: How do we advance public reporting of provider performance for consumers? Where do we want to be tomorrow? Where do we want to be in 2025? What are the challenges and how do we address them? First Step: AHRQ Summit on Public Reporting for ConsumersMarch 23, 2011 • 130 participants: • NAC members • Public and private funders of research • Federal or state policymakers • Consumer organizations • Providers • Purchasers and plans • Report hosts

  38. Survey to Inform Summit: Do you think the best current public reports of provider performance information to consumers: Meredith Rosenthal, presentation at AHRQ Summit on Public Reporting for Consumers, March 23, 2011, work funded by AHRQ and Commonwealth Fund. 38

  39. Science of Public Reporting Initiative: The Structure • A partnership among AHRQ, ASPE, CMS • Funded through ACA Section 3014 for 2011-2014 • Combination of grants, contracts, FTEs to: • Build the science • Create a user’s group • Facilitate use of new evidence • Related Activities: • Coordination Group from ASPE, AHRQ, CMS to • Create a national reporting strategy • Coordinate on quality measurement and assessment • DHHS Quality Measures inventory • Inventory of potential data sources for public reporting • Analyses to track changes in provider performance on reported measures

  40. #1 Build the Science: Pilots and Evaluations to Fill Evidence Gaps • What kinds of data do consumers/patients want, and how do we get it? • What display format is most effective? • How can we maximize consumer engagement (what timing, what type of medium, etc.) • How does the impact of a public report vary depending on other incentives and market forces such as payment strategy, market competitiveness, and payment?

  41. #2 Form User’s Group: CMS, States, Consumers, CVEs, other Community Initiatives Chartered ValueExchange Aligning Forces for Quality Other NRHI Members Other Collaboratives Beacon Communities

  42. #3 Facilitate Use of New Evidence Enhance National Quality Measures Clearinghouse Establish a coordinating center to Distill and synthesize existing evidence on “what works” in public reporting and under what circumstances. Identify promising advances in website design and medium of public reporting. Identify promising advances in the content of websites and other public reporting. Facilitate collaboration across grant sites and dissemination of early findings. Enhance MONAHRQ Report new measure set Add or refine reporting features Enhance use and usability

  43. Questions and Discussion:Science of Public Reporting Initiative • Building the Science: • What are highest priority key questions, issues? How to balance need for comprehensiveness and speed? • User’s Group: • What are most important stakeholders? How to keep the group representative yet manageable in size? • Facilitate Use: • How to balance tension between need for consistent national measures and need/desire for local innovation?

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