state scorecards: external pressure, internal change
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State Scorecards: External Pressure, Internal Change. Joseph W. Thompson, MD, MPH Surgeon General, State of Arkansas Director, Arkansas Center for Health Improvement Associate Professor, UAMS Colleges of Medicine and Public Health. 2007 State Health Research and Policy Meeting - PowerPoint PPT PresentationTRANSCRIPT
State Scorecards:
External Pressure, Internal Change
Joseph W. Thompson, MD, MPH
Surgeon General, State of Arkansas
Director, Arkansas Center for Health Improvement
Associate Professor, UAMS Colleges of Medicine and Public Health 2007 State Health
Research and Policy Meeting
Orlando, Florida
June 2, 2007
Goals in health care
COST
QU
AL
ITY
High quality/ low
cost
High quality/
high cost
Low quality/ low
cost
Low quality/
high cost
Players in the Quality DiscussionState
• Medical Doctors
• Para-professionals
• Hospitals
• Quality Improvement Organization (QIOs)
• Government
• Consumers
• Insurance Plans
• Employers (ERISA)
Federal / National
• Professional Associations
• Safety-net providers
• Agency for Healthcare Research and Quality
• Quality Organizations– NCQA, JCAHO, Forum
• Healthcare purchasers– CMS, VA, FEHBP
Tensions in the Quality Discussion• Provider autonomy vs. responsibility
• Quality improvement vs. accountability
• Data availability and accuracy– Eligibility vs. process vs. outcome information
– Cost of data access: electronic vs. chart review
– Use of electronic information systems
• Program use or public information
• Political option vs. political pressure
Pilot Study: Arkansas Employer
Healthcare Coalition
EHC Pilot Study• Healthcare purchaser coalition representing two
larger communities (Hot Springs, Fort Smith)
• Insured individuals, discounted FFS system
• Apply modified performance indicators– Mammography: Received in past 2 years / >45 y/o
– Hemoglobin A1c: Received in past year / dx of DM(II)
• Generate results on all eligibles from admin data:– Group level performance
– Provider level performance
• Report on community, group, and indivdiual level performance
Diabetes care (HbA1c)—group level*
73
%
73
%
67
%
63
%
60
%
52
%
52
%
49
%
39
%
25
%
90
%
90
%
89
%
85
%
71
%
58
%
50
%
0%
20%
40%
60%
80%
100%
G3 G7 G8 G6 G4 G1 G10 G2 G9 G5 G1 G6 G4 G3 G5 G2 G7
Fort Smith Hot Springs
*PCP facilities w/ largest # of eligible diabetic participants aged 18–75 yr
Diabetes care (HbA1c)—provider level*
90
%
84
%
77
%
76
%
74
%
64
%
60
%
59
%
57
%
57
%
10
0%
10
0%
10
0%
92
%
85
%
83
%
81
%
58
%
50
%
77
%
0%
20%
40%
60%
80%
100%
P9 P6 P3 P2 P1 P7 P8 P4 P5 P10 P3 P4 P8 P9 P6 P10 P2 P7 P1 P5
Fort Smith Hot Springs
*PCPs w/ largest # of eligible diabetic participants aged 18–75 yr
Comparison with national rates
41%
85%
64%
75%
53%
0%
20%
40%
60%
80%
100%
Comprehensive diabetes care (HbA1c monitoring)
Fort SmithHot SpringsU.S. Commercial PlansU.S. MedicaidAR ConnectCare
Translation of Data in Policy (or not)• EHC pilot results presented to State
Employees and Public School Employees Health Insurance Board (10% of state workforce) – representative membership
• Formation of Board Committee on Quality (2005) – broad membership
• Discussion ad naseum
• EHC replication project underway in plan
• Bottleneck of control & gridlock at present
• Commonwealth Fund Report (6/13) & CMS profile of hospitals (7/1) - catalyst?
