dirigo health agency’s
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Dirigo Health Agency’s. Dirigo Health Agency. Research Dissemination on quality, evidence-based medicine and patient safety Adoption of quality measures, coordination of collection and reporting Consumer education Technology assessment Promotion of adoption of electronic technology - PowerPoint PPT PresentationTRANSCRIPT
Dirigo Health Agency’s
Dirigo Health Agency
• Research Dissemination on quality, evidence-based medicine and patient safety
• Adoption of quality measures, coordination of collection and reporting
• Consumer education• Technology assessment• Promotion of adoption of electronic technology• Recommendations regarding State Health Plan• Annual report
• GovernanceDHA Board of Trustees
DHA Executive Director
MQF Director
• Funding– Share of DHA “SOP” Funds
• Guidance– MQF Advisory Council
MQF Advisory Council
• Physicians (3)• RN (1)• Hospital (1)• Mental Health Provider
(1)• Nonphysician Provider (1)• Consumers (4)
– Organized Labor (1)– Health Advocacy (1)– Uninsured/MaineCare (1)– Commercially Insured (1)
• Employers (4)– State Employees Health
Commission (1)– Large Employer (1)– Midsize Employer (1)– Small Employer (1)
• Private Health Plan (1)• MaineCare (1)• Maine Health Data
Organization (1, ex off.)
MQF PROJECTS Data Collection and Reporting
Discharge Data and Website Paid-claims Data and Health Dialog Project Hospital-reported Performance Indicators (Chpt 270)
Healthcare-Associated Infections Advanced Medical Home Pilot In-a-Heartbeat Voluntary Practice Assessment Website Development RWJ Projects: Quality Counts/AF4Q/RQS Critical Access Hospital Collaborative CON Assessment
Summary of Key Cost Drivers
• Utilization– Health Status – Preventable chronic illness
complications increase utilization– We use more outpatient and more ED than most
other New England states– Supply of technology (e.g. MRI)
• Inefficiency– 20-60% variation in cost to treat same patient for
same illness in different hospitals– Significant variation in how patients are treated by
different physicians for similar problems
Variation
• Discharge Data
• Voluntary Performance Indicator Reporting
• Paid Claims Database Analysis
Discharge Data
Performance Indicators
Performance Indicators
MQF-Health Dialog Project
Complete:• Warehoused the paid-claims data and assessed its
quality and capability to support population-based quality measures
• Conducted pilot provider profiling analysis– Primary care– Cardiology
• Conducted geographic variation analysis of advanced imaging utilization (CORE)
MQF Regional Variation in Effective Care
Percent of Diabetic Members Aged 18-64 Having LDL-C Test Performed
Measurement Period: 7/1/2004-6/30/2005
40.0
50.0
60.0
70.0
80.0
90.0
Hospital Service Area (HSA)
Ra
te P
er
10
0 E
lig
ible
Me
mb
ers
Performance Varies Across Providers
Coronary Artery Disease Gap in Care ScoreProvider Performance and Confidence Intervals (July 2004 - June 2005)
0.0
2.8
5.6
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75
Provider Rank
Mea
n C
AD
Cap
Sco
re
USING DATA TO EFFECT CHANGE
ResearchConsensus Guidelines Performance Indicators for
Providers
Benchmarking
Internal QI
Public Reporting
PHC4
NYHHC
Pay for Performance
Tiering
Steerage
Nonreimbursement
POLICYPOLICY
Advanced Medical Home Pilot
• More effective primary care, better platform for coordinated chronic disease management
• Collaborators– Maine Quality Forum– Quality Counts– Maine Health Management Coalition and Pathways to
Excellence– Martins Point Healthcare– MaineCare– Anthem, other payers
In a Heartbeat
• Standardization of Best Practices for STEMI Care
• Community Engagement• Publicity and training
• Emergency Care• EMT Systems, Cath Lab Activation from Field
• Hospitals
• Data and Metrics
Critical Access Hospital Collaborative
• Problems with standard metrics; ?”Rural-relevant” indicators
• Patient Safety issues prominent (not “n-dependent”)
• Collaborators:• MQF• USM Muskie School of Public Service• MeHAF• 14/15 Critical Access Hospitals
• Medication Safety Project(s)
RWJ: Aligning Forces for Quality,
Regional Quality Strategies• AF4Q
– Performance Measurement
– Public Reporting– Consumer
Engagement– Quality Improvement
• RQS– PM/PR of Hospital
Quality– Investigation of Racial,
Ethnic, Socioeconomic Disparities
– Nurse-centered Inpatient Quality Improvement
AF4Q/RQS
• Collaborating OrganizationsMaine Quality Forum
Maine Health Management Coalition
Quality Counts
• 50 Employer groups (MHMC)• 28 Member Organizations (QC)