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Case Study of Arkansas' Experience using the State Snapshots

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On January 17, 2008, Rhonda Jaster gave a presentation at the State Healthcare Quality Improvement Workshop, which outlined how the Arkansas Center for Health Improvement leveraged the State Snapshots to advance the organization's health care quality efforts. Please select the following link to access the slides: (PowerPoint® File, 301 KB; PDF File, 150 KB; PDF Help).

Slides: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28


Slide 1: Assessing Quality of Care

Rhonda Jaster
Prevention Specialist
Arkansas Center for Health Improvement

AHRQ State Healthcare Quality Improvement Workshop
January 17, 2008

In the lower left corner is the Arkansas Center for Health Improvement's (ACHI's) logo, which reads "ACHI, Arkansas Center for Health Improvement."

This presentation uses a template with a white background. Across the bottom of the slide is a red dot connected to a blue horizontal line that fades in to a lighter blue from left to right. To the right of the line is "ACHI."

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Slide 2: Arkansas center for health improvement

Mission:
Be a catalyst for improving the health of Arkansans through evidence-based research, public issue advocacy, and collaborative program development

Core Values:
Initiative, Trust, Commitment, and Innovation

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Slide 3: ACHI's scope of work

The slide has an image of two overlapping circles. The yellow circle reads, "Health Care Financing." The blue circle reads, "Health Promotion/Disease Prevention."

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Slide 4: Access to quality of care

There is no more pressing concern for the American health care system than improving the quality of care we provide. Improving quality of care not only enhances patients' lives, it saves lives.

— Tommy Thompson, Former US Secretary of Health and Human Services

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Slide 5: Measuring quality of care

We now know more about the quality of our nation's health plans, hospitals and medical groups than we ever have, and public reporting of performance data has had the impact we intended: it promotes continuous improvement.

— NCQA 2004 Annual Report

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Slide 6: ACHI's scope of work

The slide has an image of three overlapping circles. The yellow circle reads, "Health Care Financing." The blue circle reads, "Health Promotion/Disease Prevention." The red circle reads, "Access to Quality Care."

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Slide 7: Goals in health care

The slide shows a 2x2 table. The top of the table reads, "Cost." The left side of the table reads, "Quality."

High quality/low cost High quality/high cost
Low quality/low cost Low quality/high cost

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Slide 8: Barriers to assessing quality of care

  • Cost
  • Sample size
  • No incentive
  • Risk adjustment
  • Lack of data
  • Lack of clear purpose
  • No pressure to do so

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Slide 9: ACHI's Quality-Related Projects

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Slide 10: Employer health coalition (EHC)

  • Self-administered employer group based in Northwest Arkansas
  • Awarded Bridges to Excellence funding to develop pay-for-performance strategies
  • Lacked resources to conduct preliminary quality analysis
  • Committed to making positive changes in the care received by their employee population

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Slide 11: Quality of Care Assessment

  • Levels of assessment
      — Systems of care
      — Provider groups
      — Individual providers
  • Methods of assessment
      — Eligibility
      — Denominator
      — Numerator

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Slide 12: Quality of care measures selected

  • HEDIS measures selected to evaluate EHC data:
      — Breast cancer screening
      — Comprehensive diabetes care
      — Beta-blocker treatment after a heart attack

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Slide 13: Breast cancer screening-group level*

The slide is a bar chart. Along the x-axis is different group levels, separated by Fort Smith and Hot Springs. Along the y-axis is the percentage.

Fort Smith:

G4: 75%
G5: 75%
G6: 67%
G10: 66%
G7: 64%
G3: 60%
G2: 57%
G1: 47%
G8: 46%
G9: 19%

Hot Springs:

G4: 82%
G8: 64%
G5: 59%
G1: 57%
G2: 42%
G3: 40%
G6: 29%
G7: 0%

*PCP facilities w/ largest # of women participants aged 52-69 yr

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Slide 14: Diabetes care (HbA1c)-group level*

The slide is a bar chart. Along the x-axis is different group levels, separated by Fort Smith and Hot Springs. Along the y-axis is the percentage.

Fort Smith:

G3: 73%
G7: 73%
G8: 67%
G6: 63%
G4: 60%
G1: 52%
G10: 52%
G2: 49%
G9: 39%
G5: 25%

Hot Springs:

G1: 90%
G6: 90%
G4: 89%
G3: 85%
G5: 71%
G2: 58%
G7: 50%

*PCP facilities w/ largest # of eligible diabetic participants aged 18-75 yr

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Slide 15: Overall system-level performance

The slide is a bar chart. The chart shows results for the number of eligible patients who received breast cancer screening or comprehensive diabetes care divided by the number in the system eligible for the procedure. Data are shown for Fort Smith and Hot Springs. Along the y-axis is percentage.

Breast Cancer Screening
— Fort Smith: 45%
— Hot Springs: 36%

Comprehensive Diabetes Care:
— Fort Smith: 41%
— Hot Springs: 64%

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Slide 16: Comparison with national rates

This slide is a bar chart. Along the x-axis is breast cancer screening (mammograms) and comprehensive diabetes care (HbA1c monitoring). The bars are categorized by Fort Smith, Hot Springs, U.S. Commercial Plans, U.S. Medicaid, and AR ConnectCare. Along the y-axis is percentage.

Breast Cancer Screening (mammograms)
— Fort Smith: 45%
— Hot Springs: 36%
— U.S. Commercial Plans: 75%
— U.S. Medicaid: 56%
— AR ConnectCare: 40%

Comprehensive Diabetes Care (HbA1c monitoring)
— Fort Smith: 41%
— Hot Springs: 64%
— U.S. Commercial Plans: 85%
— U.S. Medicaid: 75%
— AR ConnectCare: 53%

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Slide 17: EHC group and provider performance

  • The group and provider level results may not accurately attribute quality results to specific groups/providers
      — Events credited to any group/provider who treated participants
      — No explicit PCP assignment available
  • Wide variations at group and provider level observed

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Slide 18: Creation of Quality Subcommittee

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Slide 19: Arkansas 2005 general assembly

  • Arkansas State Employees Benefits Division
      — Largest employer group in the state
  • Passed legislation to establish the Employee Benefits Division (EBD) Quality Sub Committee (Arkansas Code 21-5-404)
      — Review and recommend quality performance indicators for use
      — Recommend baseline performance goals
      — Recommend alignment of financial incentives to improve performance
      — Track improvements in delivery of care

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Slide 20: Arkansas employee benefits division (EBD)

  • Lacked data to establish baseline for improvement
  • Lacked infrastructure to perform analysis on existing data
  • Agency lacked resources to fulfill duties as set forth by the legislation
  • Challenge of obtaining buy-in from appropriate stakeholders

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Slide 21: Use of AHRQ Data

Use of AHRQ Data.

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Slide 22: AHRQ state snapshots

  • Provided access to data and information to establish baseline for tracking improvement.
  • Established mechanism for obtaining buy-in from all stakeholders involved.
      — Things were as bad as we thought. United by desire to improve the system.
  • Created a "snapshot" of the quality of care provided by the Arkansas healthcare system.

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Slide 23: Arkansas employee benefits division (EBD)

  • Created a plan for performing analysis utilizing existing medical claims and pharmacy data.
  • Established relationship with ACHI to provide analytic and program development resources to develop a plan to assess and improve the quality of the care provided to the EBD enrollee population.
  • Engaged the appropriate stakeholders to develop coordinated efforts in areas related to healthcare and healthcare system quality.

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Slide 24: New & Future Quality Initiatives

New & Future Quality Initiatives.

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Slide 25: EBD quality sub-committee

  • Develop a quality report to the EBD Board
      — Assist with plan and benefits development
      — Assist with the development of a "worksite wellness" program
      — Assist with developing preventative care benefits
  • Develop a consumer focused report for the purpose of making decisions around healthcare and health system utilization
  • Develop pay-for-performance strategies
  • Health Risk Assessments

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Slide 26: Regional quality initiatives (RQI)

  • Multi Stakeholder Collaborative with the AR Foundation for Medical Care and the AR Departments of Health and Human Services
  • Unify Performance Measurement
      — Share Data for Greater Accuracy
      — Discuss Incentive Opportunities
  • Explore Models of HIE
      — Research, Design Local Plan for Future
  • Health Information Security and Privacy Collaboration (HISPC), phases 1 and 2

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Slide 27: Arkansas Governor's taskforce on health

  • Lead by the Arkansas Surgeon General
      — Joe Thompson, MD, MPH - Director, ACHI
  • Staffed by the Arkansas Center for Health Improvement (ACHI)
  • Comprised of public and private stakeholders
  • Tasked with addressing healthcare and health related issues faced by Arkansans

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Slide 28: Contact information

Shirley Tyson
Research Associate/Policy Specialist
Arkansas Center for Health Improvement
1401 West Capitol Avenue
Suite 300, Victory Building
Little Rock, Arkansas 72201
ACHI Main Phone: 501-526-2244
Direct Phone: 501-526-2257
E-mail: tysonshirley@uams.edu

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