Bringing Transparency to Quality Outcomes 2015 Washington State of Reform Policy Conference January 8, 2015.

Bringing Transparency to

Quality Outcomes 2015 Washington State of Reform Policy Conference

January 8, 2015

Presenters

• Susie Dade, Deputy Director, Washington Health Alliance • Ginny Weir, Program Director, Bree Collaborative,

Foundation for Health Care Quality• Carol Wagner, Senior Vice President for Patient

Safety, Washington State Hospital Association• Rick Rubin, CEO, OneHealthPort

State of Reform Conference, January 8, 2015

Health Care Transparencyand the Value Equation

Understanding VALUE in Health Care - Six Key Variables

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VARIABLE Is the Health Care Service. . .

Appropriateness Really Needed?

Process Quality Provided in the most effective and safe manner?

Price Produced at a fair price for the buyer?

Outcomes Producing the best possible results for the patient?

Intensity/Utilization Provided in the most efficient manner?

Experience Provided in a patient-centered way?

© 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

Washington Health Alliance CurrentTransparency Initiatives• Community Checkup Quality, Patient Experience

– Medical Groups, Hospitals, Counties

• Value Portfolio Quality, Intensity, Experience, Price– High volume, high cost hospitalizations

• Disparities in Care

• Rates of Procedure Use and Diagnostic Testing

• Choosing Wisely®

• Potentially Avoidable ER Visits

• 30-day All Cause Hospital Readmissions

• Washington State legislation: FULL price transparency

5

By Hospital and Medical Group

© 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

Washington One of Only Two States with an ‘A’

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This report grades states on the percentage of clinicians with publicly available quality information, the type of measurement reported, and how accessible and useful the information is to consumers. Fifteen years after the publication of ‘To Err Is Human’ by the Institute of Medicine, there is still little, if any, useful and meaningful information on the quality of health care across the country.

HCI3 State Report Card on Transparency of Physician Quality InformationReleased December 16, 2014

Washington’s New Common Measure Set for Health Care Quality and Cost

7© 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

Unlike in quality, Washington is not differentiating itself as a leader in health care price transparency

8HCI3/CPR Report Released March 2014

F

HCI3 and Catalyst for Payment Reform2014 Report Card on

State Price Transparency Laws

F

Health Care Performance, Transparency, Improvement

1. Focus on all six variables of health care value

2. Harmonization of measures – converge around common signals

3. Transparency for:

– Purchasers

– Consumers

– Providers with continuous feedback loop

4. Support for performance improvement, especially for smaller provider organizations

5. Strongly link incentives to performance (not volume)

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Bottom Line

Transparency is a key tool for identifying, understanding, and

ultimately reducing, unwarranted variation in health care quality,

utilization and price.

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The Dr. Robert Bree CollaborativeUsing Transparency to Improve Quality

Background

Slide 12

House Bill 1311

Health PlansPublic

Purchasers

QI Organizations Hospitals

Employers

Others

Identify health care services with

high:• Variation• Utilization

Without producing better outcomes

22 Stakeholders

Process

Slide 13

Data Transparency

Provider Feedback Reports

Shared Decision Aids

Financial Incentives

Evidence-Based Guidelines

Centers of Excellence

Public Reporting

Public CommentRecommendations to improve health care

quality, outcomes, and

affordability in Washington StateClinical Committee

Our Topics

Slide 14

Obstetrics

Cardiology

Elective Total Knee and Total Hip Replacement Bundle and Warranty

Elective Lumbar Fusion Bundle and Warranty

Low Back Pain and Spine SCOAP

Hospital Readmissions

End-of-Life Care

Addiction and Dependence Treatment

Cardiology

Recommendation: COAP publicly disclose hospitals’ insufficient information reports and the appropriateness of PCI procedures

Slide 15

Insufficient Information for Determining Appropriateness in Non-Acute PCI – 2011-2013

Slide 16

Total Knee and Total Hip Replacement High volume of proceduresVariation in way procedures are doneReadmission Rates by hospital on website:

www.breecollaborative.org/topic-areas/apm/

Slide 18

Source: Readmission Rates for TKR/THR Procedures in Washington State:Summary of Findings from 2011 CHARS DataBree Collaborative – Accountable Payment Model SubgroupOctober 2013. Available: http://www.breecollaborative.org/wp-content/uploads/bree_summary_CHARS_Analysis.pdf

Transparent Quality Standards

Appropriateness

Evidence-based surgery

Rapid and durable return to function

Patient care experience

Patient safety and affordability

Slide 19

More Information

Ginny Weir, Program [email protected] (206) 204-7377www.breecollaborative.org

Recommendations available here: www.breecollaborative.org/about/reports

Slide 20

Quality and TransparencyThe Provider Commitment

Carol Wagner

Senior Vice President Patient Safety

[email protected] 8, 201521

www.WAHospitalQuality.org

Washington Hospital Quality

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www.WAHospitalQuality.org

Collaborative Learning

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Healthy Competition

“The Washington State Hospital Association has come out fully in favor of transparency. We’re finding that if you share results, you’re really allowing the patient, family and consumer to understand, ‘How good is this care, really?’

“By nature, we’re competitive. By nature, if you’re in health care, you want to improve. It’s motivating to find areas and say ‘Whoa, we aren't quite as good as we should be and in fact, most of our colleague institutions are doing better.’ It’s a very motivating thing within our membership.”

--Scott Bond, WSHA CEO

www.WAHospitalQuality.org 24

Data For Patient Engagement

www.WAHospitalQuality.org 25

Better Quality• 50,000 fewer deaths in hospitals.

• 1.3 million fewer patients harmed.

• 17 percent decline in harm.

Lower Cost• $12 billion reduction in costs.

• Healthcare price inflation was lower than the

GDP for the last four years.

Nationally

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Improving Care

Better Quality2010: 145 harms/1000 discharges2011: 142 harms/1000 discharges2012: 132 harms/1000 discharges2013: 121/1000 discharges preliminary results ever!

Partnership for Patients

Nationally

2013 fewest harm ever!

Improving Care

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Better Quality• 23,000 fewer patients harmed.

Lower Cost• $235 million reduction in costs.

Partnership for Patients

Washington

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Making a Difference for Washingtonians

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Improving Care for all Washingtonians

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Improving Care for all Washingtonians

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Improving Care for all Washingtonians

C-CDAIoT

No Control

Influence

Control

Question & Answer