Consumer Advocacy Organizations and Chartered Value Exchanges: How the Two Can Support Each Other
This is the text version of the Consumer Advocacy Organizations and Chartered Value Exchanges: How the Two Can Support Each Other slide presentation.
Slide 1: Consumer Advocacy Organizations and Chartered Value Exchanges: How the Two Can Support Each Other
A Presentation for Consumer Advocates
This slide and all following slides have the logo of the Learning Network for Chartered Value Exchanges, a puzzle with three pieces in place and a fourth falling into place.
Variation in quality of care. Access to care. Affordability. Navigation-e.g., selecting providers and coverage, understanding treatments and medications. Disparities: economic, racial, and cultural. Cultural competency-e.g., providing health care effectively across cultures. Care coordination. Preventive care.
Mistrust of employers and health plans?* Confusing coverage choices? Rising costs? Fear of errors?
*Berry, Sandra H., Brown, Julie A., Spranca, Mark A. (October, 2001). Consumers and Health Care: Quality Information: Need, Availability, Utility. California HealthCare Foundation.
Why we are all here. What we can do as Chartered Value Exchanges (CVEs). How we will help each other.
Improve quality and value of health care:
- Health Plans
- Consumer Organizations
- State or Regional Health Organizations (e.g., QIOs, RHIOs, or other State data organizations)
Image: a map of the United States. Numbered indicators are placed in various States, indicating CVEs around the country recognized by the Agency for Healthcare Research and Quality. The indicators are in the following States: 1: California, 2: Colorado, 3: Connecticut, 4: Indiana, 5: Kentucky, 6: Louisiana, 7: Main, 8: Massachusetts, 9-11: Michigan, 12: Minnesota, 13: on the border between Kansas and Missouri, 14: Nevada, 15: New York, 16: Ohio, 17: Oregon, 18, 19: Pennsylvania, 20: at the intersection of Arkansas, Tennessee, and Mississippi, 21: Utah, 22: Virginia, 23 Washington, 24: Wisconsin.
The right care, at the right time, for the right reason.
Quality of care in the U.S. is uneven:
- Risk of medical errors
- Patients receive only about 50% of recommended preventive, acute, and chronic care*
- Widespread variations and disparities in care
- Access limited by geography, health care coverage
- Patients not empowered: Lacking information and control
*McGlynn, Elizabeth A., et al., (June 26, 2003). “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine. Vol. 348. No. 26.
- Employer-sponsored health insurance
- Individually purchased health insurance
Underinsured and uninsured
In 2005, only 69.3% of diabetes patients age 40 and older received a retinal eye exam. Potential result: Blindness.
In 2005, only 75.2% of adult surgery patients on Medicare received antibiotics at the appropriate time. Potential result: Infection.
In 2004, only 62% of adults on Medicaid reported that their health care providers always communicated well. Potential result: Medication errors and poor self-care.
*Data from the Agency for Healthcare Research and Quality's National Healthcare Quality Report available at: https://www.ahrq.gov/qual/qrdr07.htm#toc
Slide 11: Community-Specific Information*
In 2005, Idaho had worse than average rates of diabetes eye and foot exams. Potential Result: Blindness and amputation.
In 2005, Idaho had worse than average blood cholesterol testing and recommended care in hospitals for heart failure. Potential Result: Worse outcomes.
Image: A map of Idaho from the AHRQ State Snapshots.
Access opens the door to the health care system. However, access to care does not guarantee good care.
Related considerations include timeliness of care and patient-centeredness of care. Patient centered care is care that considers patients' cultural traditions, their personal preferences and values, their family situations, and their lifestyles; care that makes the patient and their loved ones an integral part of the care team.
Pays the same for good and bad care. Pays for do-overs to fix bad care. Rewards volume vs. good outcomes: unnecessary/duplicative tests, procedures and medications. Pays for poor quality: complications and readmissions. Rewards technology and specialty care vs. primary care, prevention, and coordination.
Misaligned Priorities: Some insurance companies don't cover $100 annual foot exams for diabetic patients-but will pay for a $13,000 amputation.
Jan Urbina, “Bad Blood: In the Treatment of Diabetes, Success Often Does Not Pay.” The New York Times, January 11, 2006.
Preventable medical errors surrounding surgeries were estimated to cost employers $1.5 billion a year in 2001-2002.*
Preventable hospital-acquired infections result in up to $6.7 billion in additional health care spending a year in 2002. **
A pie chart shows that about one quarter of health care spending in the United States is money wasted.
*“New AHRQ Study Finds Surgical Errors Cost Nearly $1.5 Billion Annually,” AHRQ Press Release, July 28, 2008. https://www.ahrq.gov/news/press/pr2008/surgerrpr.htm
** N.Graves. “Economics and Preventing Hospital-acquired Infection,” Emerg Infect Dis [serial online] April 2004 . http://www.cdc.gov/ncidod/EID/vol10no4/02-0754.htm
Poor quality care takes a toll on patients-and their families-who may endure pain, suffering, disability, and sometimes death.
Transparent: We know what we are getting.
High quality: We are getting the right care when we need it.
Affordable: We can afford to pay for the care we need.
Connected: Patient health information is available to all treating providers and patients.
Measuring quality, reporting performance, rewarding high quality, and empowering consumers.
A graphic shows performance, availability, and quality encircled by measure, analyze and improve.
Measure only shows small growth but measure and report shows much greater growth. Care improves even more!
Transparency is necessary, but not sufficient. How can we encourage providers to improve? How can we reward those who perform best? What types of incentives will work with consumers?
We need to find answers to these questions.
Information: Help patients locate and use reliable information to help them select high-value health care providers.
Communication: Teach patients how to communicate effectively with providers.
Education: Encourage patients to take better care of themselves.
Participate in the CVE multi-stakeholder group and provide consumer perspectives. Raise awareness of quality issues with the public. Provide input on the types of patient support tools that consumers need. Offer suggestions to improve public education materials, including public reports on quality. Recommend measures for inclusion in public reports.
A photograph shows a large group of people smiling.
And how will you and the people you serve benefit from the CVE?
Provide information on quality issues and how they affect your constituents/members. Enable participation in a national network of resources and advocacy contacts. Support your efforts to communicate with the public and policymakers about health care quality. Brainstorm specific action steps your constituents can take to improve quality in our community. Share tools such as AHRQ's public service announcements.
Question Builder for patients to enhance medical appointments: www.ahrq.gov/questions/qb/
Public Service Announcements: AHRQ's campaign with The Advertising Council uses a series of TV, radio, and print public service announcements:
The image and logo of Questions Are the Answer: Get more involved with your health care.
[Your Name, Position]
[Your Phone Number]
[Your E-mail Address]