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AQA Invitational Meeting
Improving Data Reporting
Randy Johnson, Motorola
Peter Lee, Pacific Business Group on Health
Speaking on behalf of the Consumer Purchaser Disclosure Project,
Randy Johnson said he wanted to leave participants with two points:
- We have a need for nationwide measures, reflected by consensus around the National Quality Forum.
- We have the need for data aggregation initiatives, including provider-identifiable information from CMS.
Johnson highlighted Motorola initiatives in the health care arena, including:
- A series of focus groups in the early 1990s.
- Development of a measurement tool in 1994 to evaluate health maintenance organizations (HMOs) on quality of care, cost effectiveness, and patient satisfaction.
- Development of an incentive program in 1996 on health risk assessments.
- Introduction of disease management strategies in 1997.
- Introduction of incentivized disease management participation in 2001.
Johnson noted that a little more than 3 years ago, his company started looking to synchronize its health care purchasing, and came to the conclusion that it needed to focus on quality reporting and disclosure. The Consumer Purchaser Disclosure Project was formed in 2001 with a goal that by 2007 Americans would be able to select hospitals, other providers, and treatments based on public reporting of nationally standardized measures for clinical quality (safe, timely, and effective), consumer experience, equity, and efficiency.
Johnson said there were four major steps toward reengineering the health care system:
- Measurement, transparency, and disclosure using nationwide standards.
- A focus on consumerism.
- Pay for performance.
- Healthy people (we need to focus on healthy people in order to bring about the best-quality system that we can, he said).
Johnson stressed that increased transparency is already being demanded by patients, who need better tools to make good business decisions. More important, he said, we need to make improvements in quality of care. We make decisions about toasters and cars based on price, quality, and customer satisfaction, said Johnson, and we've decided we must have the same ability to make decisions about our health care.
Peter Lee, another member of the Consumer Purchaser Disclosure Project, added that there is urgency in moving forward today—not 3 years from now when CMS pilot programs are complete. There are huge stresses on the health care system today, he said, and employers are facing double-digit inflation. He added that the business community is already thinking about health plans for 2006. The question is whether there will be good high-deductible health care plans or bad ones, said Lee. If we don't do something soon, he warned, we'll have a lot of people in high-deductible plans, and this runs counter to what most physicians feel is needed for good preventive care.
Lee reiterated the need to provide better, more useable information that is based on sound science. Transparency is absolutely critical, said Lee. We'd like to go through the NQF process, but we won't wait. The employer perspective is that the drive is there now to move forward, he concluded.
The Hospital Quality Alliance (HQA) and how it had evolved were discussed. Three hospital associations recognized that they needed to work together to get better information out to the public. The message was, said the participant: Get us a common agenda and a standard set of measures that can be turned into real information for the public and real information for providers. She noted the need to move the dialogue beyond just putting out measures and toward putting real information in the hands of providers, purchasers, and consumers. This is a much more difficult task, she said, but one we should not shrink from.
Also regarding the HQA, one participant noted that stakeholders agreed that the issue was not one of aligning measures but rather one of putting in place identical measures. Another person stressed that the alliance has pledged to work through the NQF.
There was also criticism of the HQA—specifically that many people did not find out about its work until the alliance brought performance measures before the NQF.
Purchasers and consumers felt that their interests had not been as robustly represented as perhaps might be desirable, said the participant. Whatever we do on the ambulatory care side, we must have purchaser and consumer input from the very start, he said. There was also concern expressed about the lack of initial input into the HQA process by rural and specialty hospitals.
One issue that really divides those pushing the hardest for measurement and quality reporting is how accurate and reliable measures have to be before they can be used, said another participant. From the physician's standpoint, we want to be judged as fairly as possible and as accurately as possible. But, as consumers, we may be okay with information that's only 70-percent predictive of which hospital or provider is better, he said. Other participants echoed the point that people need the right tools to make the right health care decisions.
There was considerable discussion about what data to use and how to get started. Several participants suggested starting by looking at existing claims data. Another asked where to go to get access to credible claims data. Someone representing a health insurer said the plans can give information now to physicians that is actionable and patient-specific. While this wouldn't solve everything, it would be a start.
Another participant suggested not setting too lofty a set of performance measures given the claims and administrative data available today. Yet another said that physicians were concerned about using claims data for quality reporting and evaluation because they were collected based on very different criteria.
One participant noted that the barriers to rapid implementation of performance reporting and disclosure clearly center around data aggregation and ownership. We need to start figuring out the solutions and addressing the barriers to moving forward, he said. Another participant asked: How do we take the data and aggregate it in some format that is appropriate from the point of view of different constituencies, and bring it together in objective, neutral ways that protect patient privacy?
There was also some discussion about how to develop information technology collection systems in physicians' offices, and how to set up a system in which information flows through regional health data exchanges.
One participant noted that health care is local, and so is the need to aggregate data. At the same time, there is a need for coordination at all levels (local, regional, and national). Having data is okay, said the participant, but only if we are using them. The barriers to progress revolve less around the measures and more around who is aggregating the data and how the results will be acted upon, he said.
Another participant remarked that the discussion on data aggregation was very exciting. The person said that the health care community needed to construct something that can be effective in communities and that people can use to benchmark and make real improvements. We've been measuring and testing pay for performance over the last decade, he said, but these efforts have not achieved what we want.
As employers, said one participant, we try to communicate as effectively as we can to our employees. We'd like best-in-class measurements regardless of where a person resides. The person added that he'd like to see less bureaucracy and a system that is less confusing for those who deliver care on a nationwide basis. Another person suggested looking at the Veterans Affairs system, and how it tracks people as they move from region to region.
Another participant noted that there appeared to be a struggle between what can be done quickly as opposed to what can be done right. He said there seemed to be genuine consensus among the payer and purchaser communities on what to measure, adding that the real challenge was in figuring out how to measure and what to do with the results. Another person said that it was not possible to work exclusively with office-based data (that claims data were also needed). As a result, it was necessary to discuss what it means to aggregate, refresh, and report these data, said the participant.
There was also a question raised about whether there were activities that the health care community needed to stop doing in order to get traction. For example, should we stop pursuing measurement agendas? Another participant said that the goal of the Consumer Purchaser Disclosure Project guidelines was to be guided by Institute of Medicine priorities. But we also want a cost-efficiency performance measure, which doesn't currently exist, he said.
One participant suggested that efforts not start with pay-for-performance measures, because these are the most problematic from a health plan perspective. Another person said that, from an employer perspective, pay for performance is essential, as is quality improvement, if costs are to be reduced.
Bringing the conversation back to the subject of data reporting, one participant suggested building on the work of the NQF. If the goal isn't just cost containment, but also quality improvement, then this is about more than selecting a hospital or a physician. So why can't we make sure the patient gets feedback from some of these data (such as, "you forgot to refill your antidepressant" or "you're scheduled to get blood testing done")? she asked.