ahrq 2009 annual conference research to reform improving care and outcomes in uninsured populations:...
TRANSCRIPT
Center for
Health Care
Research &
Policy
AHRQ 2009 Annual ConferenceResearch to Reform
Improving Care and Outcomes
in Uninsured Populations:
The Invisible Disparity
Randall D. Cebul, M.D.
Overview: Quality of Care Among the Uninsured
1. Without claims or EMRs, the quality of care and outcomes of the uninsured are largely invisible.
– Yet we know they fare more poorly
2. Practice records-based measurement and public reporting are important for improving quality.
– EMRs are useful: timely, granular, enable CDS
– HIE (interoperable EMRs) would be even better
– Linked to regional QI/consumer engagement (CE)/payment reform, better still
– RWJF is supporting 15 communities to measure and report performance, undertake regional QI and CE
http://www.census.gov/ accessed 9-12-09
We know how many uninsured there are. 15.4% (46M), growing: 26% if publicly insured are
excluded
We know some of the financial and health consequences – to patients
• Medical bill problems/paying off medical debt climbed from 34 percent to 41 percent in the U.S. between 2005 and 2007... 72 million (Commonwealth Fund)
• Medical costs are the leading cause of personal bankruptcies (Himmelstein, AmJMed. 2009)– roughly half of all bankruptcy filers (‘07) had OOP medical
costs > $5000 before filing; 3/4 had insurance coverage
• Lack of insurance leads to foregoing necessary care– IOM: 20,000 premature deaths annually
• NONE OF THESE ARE VERY ACTIONABLE STATISTICS
“Poor Glycemic Control” Among Diabetics: The Uninsured do Worst
• 6843 patients
• One EMR-based system, same PCPs
• Uninsured: 64% higher odds (95% CI: 1.32-2.03) of poor control
• Adjusted for ASR, co-morbidities, smoking, show rates, income, site of care
Supported by grant: R01 HS-015123, Agency for Healthcare Research and Quality
Aligning Forces for Quality - 2008
OUR MISSIONBetter Health Greater Cleveland is a multi-stakeholder partnership that improves the health and value of health care provided to people with chronic medical conditions in Northeast Ohio.
We are committed to: improving care and outcomes of all people with chronic conditions eliminating disparities in health observed among disadvantaged
populations by insurance, race, education and income; and transparency across collaborating organizations, and, through public
reporting of patient care data, with our community.
AF4Q in NortheastOhio
Measurement Matters• Public reports every 6 months
• NQF endorsed, locally vetted measures
• Diverse practice organizations and sites• “Care Alliance to Cleveland Clinic”
• 8 organizations, 54 sites (42 reporting), 500+ PCPs (361 reporting) – virtually all SNPs, all FQHCs
• Paper-based practices manually abstracted ..
• Region-wide Achievement and Change by:• Insurance(M’care, commercial, M’caid, uninsured), Race (W, B,
H, Other), Income and Education (addresses geo-linked to census)
• Practice site achievement and change by insurance
Diabetes - 2008
19% Increase in Uninsured,2007 to 2008
Vs. HEDIS. Uninsured do ok – compared to Medicaid
REGIONAL ACHIEVEMENT (2008) COMPARED TO NATIONWIDE HEALTH PLAN AVERAGES (2007) ON HEDIS COMPREHENSIVE DIABETES CARE MEASURES
Measure Group Medicare Commercial Medicaid Uninsured Overall
HbA1c testingRegionNational
95.088.1
93.188.1
91.777.3
90.8NA
93.4--
Poor HbA1c Control (>9)*
RegionNational
12.329.0
18.829.4
26.347.9
35.8NA
19.3--
Eye ExamsRegionNational
69.662.7
62.055.1
44.249.9
48.5NA
61.5--
LDL-C ScreeningRegionNational
89.985.7
89.483.9
75.070.8
77.4NA
86.8--
LDL-C Control (<100)
RegionNational
61.346.8
53.843.8
38.331.3
36.7NA
53.0--
MonitoringNephropathy
RegionNational
91.885.7
89.480.6
86.674.4
87.0NA
89.7--
Blood PressureControl (<130/80)
RegionNational
38.531.7
38.632.1
36.129.5
31.7NA
37.5--
Blood PressureControl (<140/90)
RegionNational
66.158.9
71.363.9
59.755.5
62.6NA
67.3--
*Lower rates are better for this measure.
Overall, we’re improving on our composite measures
And most practices have betteroutcomes and better care processes
But our Uninsured are not Improving
Thank you
Visit our website:
http://www.betterhealthcleveland.org